EMplify - September 2021

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Abnormal Uterine Bleeding in the Emergency Department

Authors:

Tazeen Abbas, MD

Abbas Husain, MD, FACEP

Physiology review

Terminology

Differentiating Causes: PALM-COEIN

Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia

Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified

Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise

Age Based Differential

12-18

Immaturity of the hypothalamic-pituitary- ovarian axis

Sexually transmitted infections

Coagulopathies, and bleeding disorders (von Willibrand disease)

19-39

polyps

fibroids

malignancy

PCOS

Age 40 and older

endometrial atrophy

malignancy

History

Physical Exam

Diagnostic Studies

Treatment

Unstable

Stable

Special Cases

DOACs

Prepubescent girls

genital injuries